By naturopath Margaret Jasinska

Everyone who has an autoimmune condition needs to take extra care of their liver. Abnormalities in intestinal health are present in all autoimmune diseases; not just those affecting the digestive system. Having a leaky gut and an overgrowth of bad gut bugs can cause injury to liver cells. Long term injury can cause inflammation and the development of a fatty liver.

An excessively permeable intestinal lining (leaky gut) is present to varying degrees in all autoimmune conditions. When wastes, toxins and microbes leak through the gut wall, where do they go? Straight to your liver. There is one main vein (the hepatic portal vein) that takes all blood from the gastrointestinal tract to the liver. Ordinarily this is a good thing because this blood is extremely rich in nutrients. Your liver is the hardest working organ in your body and it has a high need for nutrients. Your liver is also designed to trap any microbes or foreign matter that may have escaped through the gut, preventing it from spreading to the rest of your body.

If your intestinal lining is inflamed and leaky, your liver will quickly become overwhelmed. There are specialised cells inside your liver called Kupffer cells. They are a type of white blood cell called a macrophage; it comes from the Greek words big eater! The job of a macrophage is to engulf foreign matter, a lot like Pac Man. Macrophages contain enzymes that enable them to digest the debris or toxins they’ve swallowed.

In people with a leaky gut, the high level of wastes arriving at the liver will trigger a great deal of inflammation inside the liver. One of the most harmful substances to travel from the gut to the liver is lipopolysaccharide. This is a type of endotoxin. It is a substance found in the cell wall of gram negative bacteria in the gut. If you have an overgrowth of bad bacteria in your gut, and if your gut is leaky, high levels of endotoxins will be arriving at your liver all the time.

Intestinal endotoxins stimulate Kupffer cells to produce high levels of inflammatory chemicals called cytokines. Some examples include interleukin 6 (IL6), Tumour Necrosis Factor alpha, and interleukin 1. These inflammatory chemicals are responsible for a lot of the symptoms of autoimmune disease, such as fatigue, pain, fluid retention and redness of the skin. They also affect your mood and cognitive abilities, promoting foggy head, poor memory, depression or anxiety. Lipopolysaccharide is a known pyrogen, meaning it can induce a fever. A mild fever unrelated to an infection is a very common symptom of autoimmune disease, and it can cause poor quality, disturbed sleep.

Over time, the liver will eventually become inflamed and start producing high levels of free radicals known as superoxides. These molecules are highly damaging to your entire body and they accelerate your rate of ageing, increase inflammation, pain and mood disorders. It is very common to see mildly elevated liver enzymes on a blood test result of a patient with autoimmune disease. We also sometimes see a fatty liver on ultrasound. The liver accumulates fat inside it as a side effect from all the inflammatory damage. You do not need to be overweight to have a fatty liver. A blood test may also show elevated levels of inflammatory markers called C-reactive protein and ESR (Erythrocyte Sedimentation Rate).

If the liver is inflamed and overworked, it is not able to cleanse and purify your bloodstream adequately. This leads to an accumulation of metabolic wastes and inflammatory chemicals in the bloodstream, chronically stressing the immune system. This can lead to a worsening of an autoimmune disease or allergic condition.

There is detailed information on how to heal your gut and restore your liver health in our book Healing Autoimmune Disease: A plan to help your immune system and reduce inflammation.